“Cognitive performance decreases during migraine attacks, especially in reading and processing speed, verbal memory and learning, supporting patients’ subjective complaints. These findings suggest the existence of a reversible brain dysfunction during attacks of migraine without aura, which can relate specifically to migraine or be a consequence of acute pain processing by the brain.” Study

This study makes a great deal of sense to me. All the things we are familiar with. Processing speed, by the way, is something I researched on a study for fibromyalgia cognitive dysfunction. And it wasn’t affected for FM. Processing Speed is “one of the measures of cognitive efficiency or cognitive proficiency. It involves the ability to automatically and fluently perform relatively easy or over-learned cognitive tasks, especially when high mental efficiency is required. That is, for simple tasks requiring attention and focused concentration. It relates to the ability to process information automatically and therefore speedily, without intentional thinking through.” ETFO

And we know our attention and focused concentration can tank. As well as having issues with reading comprehension and forgetting how to do things we have done thousands of times before.

And we know it is reversible cognitive dysfunction as well.

In contrast, other studies showed no evidence linking migraine to accelerated cognitive decline over time, including a study of elderly people with a lifetime history of migraine (Cephalalgia. 2011;31:1291-1300).

You know many of us say that medications like Topamax (often called dopamax) just make things so much worse. But one study suggests, nope, it is the chronic migraine to blame and not the medication at all.

“After linear regression that considered topiramate, depressive disorder, anxiety disorder and non-reparative sleep, migraine continued to be the only relevant factor regarding poorer [cognitive] performance,” Study

That study was specifically on chronic migraine as well. I am not sure I concur with it. I felt utterly brainless of Topamax. And with depression, it didn’t seem to help. But you know, I have some serious cognitive issues from just the migraines and I am sure many of you do as well. It can be scary at times. Like thinking through pudding. Knowledge you have is just not able to be retrieved when you need it. Things are confusing. You can’t seem to ‘hold’ information in your brain long enough to use said information. There can be major issues with language, math, and memory. And for me, it has gotten a lot worse with vestibular migraine… to the point it is difficult to manage simple things.

Nevertheless, I do not think this particular study is accurate when it comes to Topamax. Because it seems it gets significantly worse and then better as you adjust to the medication.

I am not even sure if it is accurate on depression either but I always had a hard time with knowing what was causing my cognitive impairment: Depression, fibro fog, or migraine… or all mixed into a serious case of dumbified.

The results of the study

Migraine was the only relevant factor associated with poorer performance on the MoCA, Verbal Fluency, Clock Test, and Stroop Test parts 2 and 3 in a linear regression analyzing chronic migraine, use of topiramate, major depressive disorder, generalized anxiety disorder, and nonrepairing sleep as independent variables.

The researchers also interviewed participants regarding frequency and intensity of headaches and doses of any daily medications, including topiramate.

Results showed no difference in cognition between in the migraine group and the 15 participants taking topiramate and 15 others not taking the drug. Although this medication was not associated with significant cognitive impairment, patients taking topiramate did have an attention deficit, which explains the poorer performance on the Digit Span and vocabulary tests, said Ferreira.

“Surprisingly, patients with depressive disorder only had a worse performance on the Matrix Reasoning test,” she added.

And I have to caution with the result. Apparently there a lot of these on cognition and migraine, some of which are controversial, so I’d take this one with a grain of salt.

Hi Nikki – I’d be interested in your findings when you researched processing speed related to fibromyalgia cognitive dysfunction. Is that in the links you provided, or is there more? (I’m fairly new to your blog.)
Re: Topamax, I was placed on it off-label many years before it was prescribed for chronic migraine. I was prescribed 450mg a day, which I took diligently for 4 years. That was back in the days when asked few questions, because I trusted doctors who were highly published and who told me that drugs were the only way to help chronic migraine. I can remember very little from those 4 years, except falling repeatedly in public, vertigo, and not being able to understand what anyone was saying to me. I was a total zombie. What’s hilarious to me is that when I finally woke up and put two-and-two together, and asked to be taken off it, my (new) neurologist wanted to stop it cold turkey. When I said I’d rather titrate down slowly, the egomaniacal idiot responded “OK, we’ll do it your way,” in a sarcastic tone. Since then, I only have doctors on my care team who will collaborate in care with me. No more one-sided affairs where I am not actively involved in deciding what the treatments will be.

I can’t believe your neuro just wanted to drop the Topamax cold turkey. That is insane. I had a neuro who wanted me on 350mg. I didn’t make it up to it. Like you said, I just got zombified and confused. Also sick, with horrible nausea.

I’ve read a lot of horror stories about Topamax. For me, it has been a life saver in many ways. I went from having a 3 month long migraine to having around 6-10 a month. I do realize we are all so different. I know I have some side effects to the drug: I can’t taste carbonated drinks. However, my brain fog and cognitive abilities were impaired from dysautonomia and fibromyalgia before starting Topamax, so I’m unsure how much more I’ve been impaired. I do know I wasn’t going to live much longer in a nonstop migraine attack vomiting, crying out wondering if dying would be better. Gentle hugs to all migraine sufferers. ❤️

I agree. With FM and chronic migraines… I have no idea what effects were Really to do with the Topamax. However, in my case all the weird little side effects diminished after I had been at the right dosage for three or so months. It just didn’t work for me. But it is the number one preventative for chronic migraine for a reason as it helps so many people. I am really glad it works well for you!

I’ve been on a high amount for many years . The initial brain fog subsided but I still when I have a migraine lose the ability to carry a conversation without forgetting words which I know is from the migraines as I had this before I took Topomax. My husband had a hard time with this bit now fills in the words for me thank heavens. I don’t have the violent vomiting I used to have. Now I can tolerate it. My migraines are chronic & sometimes horrible but much better than before my Topomax.

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This blog is not a substitute for medical advice and serves only to help you to be your own advocate and to make migraine disease more visible and understood. Please do not claim the information on this page as your own, and acknowledge the writer accordingly.

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